C09988990 / invoice 10000

Reason: Dispense Codeine O called to request that codeine be dispensed for cough suppression, as previously discussed.    Vital Signs    

Reason: CoughingAppointment Notes: STABILISATIONcoughing a lots, PC appt is not available today and owner can't do it tomorrow.   O does not mind about cost.  She will monitor it and if needs will bring Bam Bam in.ADE -- 4/23/26 -- EVENING SHIFTTime of consult: 16:40pm on 4/3/26 History:O (Nicolette) presents todayPresents for acute onset new characteristic cough. Since radiation for previous tonsillar SCC has had chronic cough. Since then once to twice a day. This cough tends to be random, unsure if its related to eating/drinking/exercise. After these episodes is okay. Today has developed a new type of cough. Trialled a gabapentin, but this didn't seem to do anything. More harsh and lengthier in duration. Terminal retch at the end. No nasal discharge. Still behaviourally okay. O feels like Bam Bam may have chronic reflux. No V+. Stools fine. No bones.Has a long previous medical hx - see previous records. Examination findings:BAR - nervousHR = 132, HR=PR, pulses strongRR = 24, RE=0/3Mm/crt: pink, 1secTemp: 39.2 PLNs: L pre-scap prominent, rest WNL Eyes/ears: unerarkableCVS: g3/6 murmur, louder on L sideResp: clear in all lung fieldsNo overt laryngeal sensitivityAbdomen: slightly pot bellied in apperance, comfortable on palpationTFAST: no b lines, no pleural effusion, no pericardial effusionAFAST: no FAF Assessment:Acute coughPrevious ongoing chronic coughSuspect gastric refluxHistorical tonsillar SCC in remission Prominent L pre-scap LNKnown MMVD Bam Bam presents for an acute cough. He is CVS stable on presentation, with no respiratory compromise. The cause of the acute cough remains open, consider primary respiratory (infiltrative vs infectious vs other) vs secondary respiratory (eg: mass in anatomical area)  - however with the extensive previous medical hx (esp with previous neoplasia in the laryngeal region) prudent to investigate and screen for further underlying disease process. Client communications- Discussed with O about presentation- Discussed that woudl recommend further investigation if wanting to know the exact cause of cough - Discussed ideally should be with medicine, next available on Fri @ 12pm, O is available to present for this consult- Discussed case with Dr BL- Discussed can provide codeine in the interim for cough suppressant, O elects to HOLD for now, but will pick it up tonight or tomorrow if she feels like its required Treament: Nil additional for now Plan: O may pick up codeine linctus for the cough. If required, can prescribe 1mg/kg PO q12hrs as required. Medicine appt on this coming FriRepresent through ECC if acute declineHx sent to ref vet    Vital Signs